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Special Event - 34th Annual Stand by Me Walk - June 8, 2024
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Special Event - 34th Annual Stand by Me Walk - June 8, 2024
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4/14/2025 2:29:10 PM
Creation date
11/29/2023 10:40:10 AM
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Board of Public Works
Document Type
Recommendations
Document Date
11/28/2023
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CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDD/YYYY) <br />11 /30/2022 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />R SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement/al- <br />PRODUCER <br />Gibson Insurance Agency Inc <br />202 South Michigan St., Suite 1400 <br />South Bend IN 46601 <br />PRONE <br />We xe - 574-245.3500 Wc. No1: 574-236.6399 <br />INSURED REALSER411 <br />Services, Inc. xaIAeERs: <br />Real S <br />1151 S Michigan St INSURER C <br />PO Box 1835 INSURER D: <br />South Bend IN 46634 <br />COVERAGES CERTIFICATE NUMBER: 2124897635 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSLTR <br />TYPE OF INSURANCE <br />L'WIND <br />POLOYNUMBER <br />POLICY FFF <br />POLICY EKP <br />LDS <br />B <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CILMMS-MADE "" OCCUR <br />PHPK2436533 <br />7/1/2022 <br />7/l/2023 <br />EACH OCCURRENCE <br />$1,000.000 <br />PREMISES Ea ocwnerKe <br />$100,000 <br />MED EXP (Any one person) <br />$5.000 <br />PERSONAL f ADV INJURY <br />$1.000.000 <br />GENT <br />AGGREGATE LIMB APPLIES PER: <br />POLICY n JJEEC L] LOC <br />OTHER <br />GENERAL AGGREGATE <br />f3,000,000 <br />PRODUCTS - COMP/OP AGO <br />S3.000.000 <br />S <br />AUTOMOe1LELUBILRY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PHPK2436533 <br />7112022 <br />7/1/2023 COMBINEDLE LM <br />Es a denl ING <br />BODILY INJURY(Per pemon) <br />BODILY INJURY (Per ecddenu <br />PROPERTY DAMAGE <br />(Per eryldenl <br />i11000,000 <br />X <br />S <br />S <br />X <br />_ <br />S _. <br />S <br />B <br />X <br />UMSRELLAUAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />PHUS822607 <br />7/12022 7/1/2023 EACH OCCURRENCE <br />AGGREGATE <br />$2.000.000 <br />$2.000,000 <br />f <br />DED RETENTION <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRIETORAPARTNEREXECUTIVE <br />OFFICERMEMBER EXCLUDED? ❑ <br />(MAndalory In NH) <br />X yes, desc lm under <br />DESCRIPTION OF OPERATIONS W. <br />N/A <br />WCV6146654 <br />7112022 <br />71112023 <br />',X BE <br />I STATUTE ER <br />E.L. EACH ACCIDENT <br />S500,000 <br />E.L. DISEASE -EA EMPLOYEE <br />S500,DD0 <br />6 500,DDO <br />EA_ DISEASE -POLICY LIMIT <br />DESCRIPTON OF OPERATONS I LOCATIONS I VEHICLES (ACORD 101, AdlNoml Remar o SCMdYM, may be eeeeMd N m apace le rpeired) <br />'FOR INFORMATION ONLY' <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />coihson x,rr711i#7A _.!i jT710 <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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